26. Successful implementation of the interim CDC precautions during the care of a patient with C. auras colonization in an inpatient rehabilitation facility and an intensive care unit
Session: Posters in the Park: Posters in the Park
Wednesday, October 3, 2018: 5:30 PM
Room: N Hall D Opening Reception and Posters in the Park Area
Posters
  • C auris IDSA poster 4x6.pdf (984.2 kB)
  • Background: A 56 year-old-woman with a history of intra-abdominal C. auris infection following an elective liposuction procedure in India was admitted for neurological rehabilitation to our inpatient rehabilitation facility. She had been treated with multiple antibiotics as well as 21 days of anidalufungin prior to transfer to our facility. Ten days after her arrival she was transferred to the intensive care unit of our acute care hospital for severe sepsis and was started on broad spectrum antibiotics and micafungin. After thirty days in the ICU, she was found to have hemorrhagic stroke with uncal herniation and care was withdrawn.

    Methods: While at the rehabilitation center and the acute care hospital ICU, the patient was housed in a private room with an anteroom. Equipment used for therapy, respiratory care, medications, and nursing supplies were dedicated and discarded after discharge. A limited number of therapists, nurses, and physicians were assigned to her case and strict contact precautions were followed. Daily cleaning was carried out with 10% bleach. After discharge, rooms and equipment were disinfected with hydrogen peroxide vapor twice. The ICU room was cultured after disinfection and all cultures were negative. For surveillance purposes, the patient was assessed for skin colonization several times during the hospitalization. All non-sterile site yeast isolates from patients in those units were speciated during her stay and up to a month after.

    Results: The patient’s initial urine and skin cultures grew Candida species which was later identified as C. auris by MALDI TOF with the following MICs: FLU >256, AMB 2, and MFG 0.5. While the patient remained colonized during her stay, there were no other cases of C. auris infection or colonization at either location.

    Conclusion: C. auris is an emerging nosocomial pathogen that is generally resistant to azoles and has variable resistance to amphotericin B and echinocandins. Our case shows that it is possible to prevent the spread of C. auris both in rehabilitation and acute care units when the CDC interim recommendation are followed.

    Melissa Reimer-McAtee, MD, Internal Medicine, University of Texas in Houston, Houston, TX, Elizabeth Reed, BCN, RN, Infection Control, Texas Institue for Rehabilitation and Research, Houston, TX, Gabriela Corsi, MD, Infectious Diseases, University of Texas, Houston, TX, Kelley M Boston, MPH, CIC, Memorial Hermann - Texas Medical Center, Houston, TX, Harika Yalamanchili, DO, Infectious Disease, The University of Texas Health Science Center at Houston - MD Anderson Cancer Center, Houston, TX, Audrey Wanger, PhD, Department of Pathology and Lab Medicine, Department of Pathology and Laboratory Medicine, McGovern Medical School, Houston, TX, Violeta Chavez, PhD, Department of Pathology and Lab Medicine, McGovern Medical School, Houston, TX, Sonia Bassett, BSN, RN, COS-C, Memorial Hermann Hospital, Houston, TX and Luis Ostrosky-Zeichner, MD, FIDSA, FSHEA, Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, Houston, TX

    Disclosures:

    M. Reimer-McAtee, None

    E. Reed, None

    G. Corsi, None

    K. M. Boston, None

    H. Yalamanchili, None

    A. Wanger, None

    V. Chavez, None

    S. Bassett, None

    L. Ostrosky-Zeichner, None

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